INTRADUCTAL PAPILLARY ADENOCARCINOMA WITH MUCIN HYPERSECRETION AND COEXISTENT INVASIVE DUCTAL CARCINOMA OF THE PANCREAS WITH APPARENT TOPOGRAPHIC SEPARATION

We report a 66-year-old man who had a cystic intraductal papillary ade nocarcinoma containing a papillary adenoma, in the head of the pancrea s and a coexistent invasive, well differentiated solid tubular adenoca rcinoma in the tail of the pancreas. He was hospitalized with acute ep igastralgia. Computed tomography demonstrated a multilocular cystic ma ss in the head of the pancreas and a solid tumor in the tail. Endoscop ic retrograde pancreatography showed mucin secretion from an enlarged papilla of Vater, marked dilatation of the main pancreatic duct in the head and body, cystic dilatation of the uncinate branch, and irregula r narrowing of the main pancreatic duct in the tail. Total pancreatect omy was performed. Between the cystic tumor and the solid tumor there was a distance of 4.8 cm of normal pancreatic parenchyma and duct, rec ognized both grossly and microscopically. The patient died 35 months a fter the operation. At autopsy, peritonitis carcinomatosa was found in the abdominal cavity. Microscopically, disseminated nodules were also well differentiated tubular adenocarcinoma. The apparent anatomic sep aration of these two tumors within the pancreas is extremely unusual.